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Child Sexual Abuse Accommodation Syndrome is a simple and logical model used by clinicians, courts and other institution to improve the understanding and acceptance of a child's position in the complex web of sexual victimization.As child sexual abuse is on the rise in our society, as an estimate of 500,000 new incidents are reported in the United States each year, this syndrome helps educate individuals. Roland C.Summit introduced this non-diagnostic syndrome in 1983 to help the victims behavior be accepted in the public eye. The syndrome is composed of five categories;(1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. This syndrome does not prove that sexual abuse has taken place, instead establishes a pattern of behavior which is present in some children in child sexual abuse cases.Child Sexual Abuse Accommodation Syndrome is impressionistic, rather than demonstrated by empirical research. Child Sexual Abuse Accommodation Syndrome featured heavily in the satanic rituals of the 1980s and 90s, because it purports to explain both delayed disclosures and withdrawals of false allegation of child sexual abuse.Child Sexual Abuse Accommodation Syndrome is used to justify any statement made by a child as an indication that sexual abuse had occurred—immediate disclosure was an indication of abuse, as are delayed disclosure, withdrawal and sustained denial.[2]

History of Child Sexual Abuse Accommodation Syndrome
Doctor Roland Summit was the first to propose the existence of child sexual abuse accommodation syndrome is 1983. Summit defined it as "The occurrence of five behavior patterns that may result from sexual abuse; secrecy, helplessness, entrapment and accommodation, delayed disclosure and retraction. Secrecy and helplessness are precursors to the crime. The victim must tell no one, and the imbalance of power gives way to the next element, helplessness. Entrapment and accommodation, delayed disclosure and retraction are resulted from the abuse and the child's attempt to cope with the trauma. Entrapment and accommodation happens because the child feels powerless to stop the abuse. Delayed disclosure happens because the child believes he/she may be in danger if they do not co-operate. This may be because the offender threatens them or their family. The last behavior pattern occurs because the child feels retraction can lead to the return of a "normal" state of life. This may be caused by pressures from the family, themselves, or even the abuser. Studies show that 22% of children who step forward later retract their statements.

Doctor Roland Summit intended the proposal of child sexual abuse accommodation syndrome as a way to help psychologists understand the behavior of child that had already been abuse. It was not meant to diagnose children who exhibit these five behaviors who have not been abused. The correct way to implement child sexual abuse accommodation syndrome to explain the behavior from preceding abuse.

Secrecy
No child can be prepared for the molestation from a trusted adult. It is an act only committed when the child is alone with the adult, and it must remain a secret, never to be shared with anyone. The offending adult will use any tactics, logical or illogical, to appear to the child's sense of danger or fear. Example of what the adult may say include, "This is our little secret, don't let anyone know." or "Don't tell your mother, it'll kill her, and you'll break up the family." These tactics are a mix of threat and also a solution. The child believes as long as he/she keeps this secret, everything will be fine. Even if the child is brave enough to tell another adult immediately, many times it is met with silence. They may be told not that things like that can never happen in this family or how could they make up such a horrible story. If a child chooses to disclose to abuse after it has happened for a while, many realize they won't have a chance to. They may be met with questions like "Why would you tell me this now if it happened so long ago?" or "What are you trying to hide?" Unless the sexually abused child can confide with a non-judgmental, trusting adult, they usually end up insecure and afraid of intimacy.

Helplessness
Children are taught not to speak with strangers or avoid their attention, but are usually taught to obey and trust related adults or adults put in charge of their care. Unfortunately, this distracts attention from a more immediate risk, the betrayal of a relationship between a caregiver and a child. Surveys conducted estimate 10% of all females have been a victim of child sexual abuse, and almost 2% by their own father. The fact that the perpetrator is a trusted adult increases the sense of dread and helplessness.

Society expects one certain reaction when a child wakes up and finds an adult exploring their bodies with their hands or mouth, which is to physically resist, call for help and to use any method to escape the abuse. Most children fail this expectation. Almost all of them "play possum", which is to pretend to be asleep or lie there and take it. Because of this many children are ripped apart in court because they admit to failing to make any protest. Children are made to feel ashamed of their helplessness to communicate their feelings as most adults condemn anyone who submits easily to intimidation. Adults should remember that to a dependent child, the fear of losing family or love is much more threatening than the threat of violence. It is because of this offending adults quickly realize that dependent child are helpless to resist or complain.

Entrapment and Accommodation
Child sexual abuse does not usually occur once; it is very likely to be repeated several times especially when the child is in a dependent relationship with the offender. The offender may have feelings of guilt, fear and may consider terminating their behavior. It may be hard for the offender to stop their behaviors due to the simplicity of their offence it may become hard to avoid leading to addiction.

If the child does not seek help or medical attention, there will be no solution. The child will soon begin to feel the need to live with the situation and to accommodate the fact that they are being sexually abused continuously. This leads to a conflict for the child, as the adult is seen as someone that is a loving and protective figure. Consequently, the child accepts the abuse and will try to live on and survive.

The challenges the child faces in terms of survival will include: pathological dependence, self punishment, self mutilation, selective restructuring or reality and multiple personalities. It is crucial that the medical professional (therapist) dealing with the child not over look these symptoms that may lead the child to feel the development of another disorder.

Further on, it is essential that the child begins to develop some level of power and control. The need for a parent or guardian as a protective and authoritative figure must decrease in order to develop their confidence and level of acceptance.

The offender may be a parent in many situations. In this case, the parent most likely emotionally blackmails the child in terms of family welfare. For example, the parent may state “if you tell anyone, then Daddy will go to jail and you and your siblings will have to live in a shelter”. By stating such statements the abusing parent gives the child demands and obliges them that they must follow or else. It can be seen as an explicit or implicit award. By using this method the child will not hesitate and will meet the abusing parent’s sexual demands. This puts the child in an authoritative position as they decide the family's welfare.

In the child’s mind, telling someone else the truth would seem to be a mistake (trouble causing) and keeping the abuse a secret would be the ultimate goal. Thus they are obliged to meet the parents demands.

The compliance leads to different symptoms in both female and male victims.

Female Victims
Female victims tend to exhibit behaviors such as : self-hate, self-mutilation, suicidal behavior, promiscuous sexual activity, and attempted runaways. The female victim may also try to manipulate the offender for extra advantages or allowances. This may lead the female victim to develop a self image of that of a prostitute or sex worker.

The female victim tends to have hard feelings toward the mother, if the male parent is the offender. She may feel that the mother is not fulfilling her duties toward the father and may feel that the mother is the sole reason to blame for her abuse. The female victim may also feel that the mother is aware of the sexual abuse, but does not care for her and her well being. This will lead the female victim to develop feelings of low self worth. These factors lead to the mother daughter bond to weaken and several issues between the mother and daughter can arise in the future in terms of relationships.

Male Victims
A male victim of sexual abuse is will release his frustration out in the form of aggression and antisocial behavior. The male victim is more likely compared to a female victim to take benefit and manipulate the offender towards his own benefit. A number of symptoms may come into play such as depression, counter phobic violence and misogyny. Both genders are highly likely to turn to substance abuse as an option to escape the feelings of tension, depression and rage.

Delayed, Conflicted and Unconvincing Disclosure
The majority of child sexual abuse is never disclosed. Reported or investigated crimes are rare and are usually a product of unmanageable family conflict, accidental discovery or outreach from a community social service for child abuse instead of self reported. Since this is the case, many discoveries of abuse are not made until the child reaches adolescence when he/she becomes more capable of independence or defying authority.

Even if it is the victim him/herself that reveals this secret, chances are he/she is not believed. Imagine this, a father has been sexually abusing his daughter since she was young. Now she is in her adolescences. One night after after a family fight where the father is being authoritative, the angry daughter spills the secret. When most adults hear of this, they tend to believe that the daughter was momentary angry about her punishment, rather than choosing to believe there was truth to her statement. They assume the seemingly perfect father is trying to impose reasonable restrictions on his teenage daughter and that she is doing whatever to get away from it, even if it means falsely incriminating her father. Unless specially trained, adults relate better to another parent trying to deal with their rebellious teen much easier than believing a child could tolerate incest without immediately telling someone. This was only one scenario, as not all adolescences let go of the secret in anger. Some adolescences who suffered from child sexual abuse may become unusually high achieving students or athletes. When one of these victims speak out about their abuse, the normal reaction from adults is once again disbelief. Many question how such a fine young person could possible have suffer such trauma. In most cases it is seen as a cry for attention. Whether the child is a delinquent or perfectly well adjusted, there seems to be no upside for his/her complaint.

Contrary to popular belief, most mothers do not know about the ongoing abuse. Most are blinded by the belief that their marriage partner could never do such a thing. When confronted the mothers have to choose between a lying child or an unfaithful husband. With thoughts like "How could I not have known?" running through her head and logical arguments likes "How could I have done something like this all these years under your roof?" presented by her husband, many will just choose to believe that their child is just going through a rebellious stage. Of the minority of mothers who believe their child, even a smaller percentage of cases are ever revealed outside the family. Most try to negotiate a resolution within the family as no one would want to bear the shame of the secret getting out.

If by chance a case reaches to court, one has to remember to be convicted of a crime the court has to requires proof "beyond a reasonable doubt." As all jurors must be adults, they can reasonable assume a child can have a fantastic imagination and most will not risk convicting a respectful adult and parent over what could be false claims.

Retraction
Family honor and welfare play critical roles in the last stage of Child Sexual Abuse Accommodation Syndrome. The abused child may change or alter their statement (retract from case in all). This is largely due to family pressures as the father will deny the child’s statements and charges. The mother will also not believe the statements, as she is unaware of the abuse. In this situation the child is put under a lot of pressure, as the child will be blamed for any inconveniences caused to the family, such as imprisonment of the offender, loss of income and home, dependency on welfare, absence of patriarch from home, intervention of children agency and affect on other siblings (put into foster care) and so on. The child is once again faced with an important and ambiguous situation, they can either escape the abuse or have the offender charged leading to family conflicts, or they can remain silent and live with the abuse.

In the majority of cases the abused child has retracted from their accusation or complains of abuse. The child will usually also state that their statements were a story they made up in an effort to get their parent in trouble as they were upset with them.

Oedipus and Electra complex
Sigmund Freud has described this concept using the psychosexual theory of personality development. The Oedipus and Electra complex tends to form during the phallic stage of development. According to Freud's theory, children of both genders form sexual attachments to the parent of the opposite sex and tend to envy the parent of the same sex during this period.

Freud described the Oedipus concept as the male child having sexual desires toward his mother and has envy of his father. The male child viewed the father as a risk believing that the father may affect or intervene between the child’s relationships with his mother and in the end punish the male child with castration.

The female version of this complex is the Electra complex, where the female child has sexual desires towards her father and views the mother as a risk factor affecting her relationship with her father. The female child develops this relationship with the father after realizing that she does not possess a penis and that her father does. Freud described this as penis envy, as the female child believes that she will be able to acquire a penis after forming such a relationship with her father.

The conflict of complexes is resolved through the process Freud described as identification. During this stage the child now reverts their attention towards the same sex parent. At this time the child will begin to learn and mimic the behavior of the same sex parent in other words will look up to them like as an idol. At this stage the feelings of risk and envy are solved. The children learn and acquire gender roles. According to Freud the superego also develops and forms during this stage.

Research
Sexual abuse is a major societal issue that is faced by many countries, despite of developing or developed status. Despite this, the number of children that face sexual abuse is very difficult to determine. The reason why this data is underdeveloped is because figures are estimated and brought forward by Child protecton agencies. The second reason is that diagnosing a child as a victim of sexual abuse is a very difficult task, the accuracy of the diagnosis is questioned. This is because in the majority of cases that are brought forward there is insufficient medical and physical evidence that can lead to the conclusion of sexual abuse. Furthermore, there are many cases that are silenced and not brought forward at all. Due to the lack of this form of evidence, the child's statements about the abuse is the major form of evidence that is mainly used to determine if indeed sexual abuse has occurred or not.

As the child's statements are used to judge the concurrence of sexual abuse, it is crucial for professionals to interpret this information correctly and in the least damaging method as possible.

Several experts in this field have stated that a significant problem with depending on the statements provided by children victims of sexual abuse is that the majority of these children hesitate in coming forward with the truth and may keep the abuse a secret. The children may state that the abuse did not occur while it has in reality. They may also make several other statements in attempt to cover up the fact that they have been abused. The series of stages these children go though is referred to as the Child Sexual Abuse Accommodation Syndrome.

Rape Trauma Syndrome
Child Sexual Abuse Accomodation Syndrome is very similar to the rape trauma syndrome in terms of the instances of abuse and rape these victims also face. In addition, family honor plays a critical role in both syndromes. However, in cases of rape, it is often perceived by others that the female victim was either exhibiting provocative behaviour or appearance, therefore bringing about the incident of rape onto herself.

Many women do not publically disclose their assault. In order to protect their character and personality. Those that have reported the assault and have gone pulblic have often reported feelings of regret as it has affected their image in society.

A study conducted at the Boston Hospital Counselling Program, summarized in the article: Sexual Trauma of Children and Adolescents: Pressure, Sex and Secrecy states that: "“The emotional reactions of victims result from their being pressured into sexual activity and from the added tension of keeping the act secret.” The article goes into further depth of the emotional reactions depicted by the victims of sexual abuse as well as the obligation to keep the abuse secret. This may be due to society’s disbelief and due to the feelings of rejection experienced by the victim.

Hysteria
Childhood abuse hysteria syndrome is a useful tool in determining if a child is telling the truth in an abuse situation. The hysteria of the child does not refer to an uncontrollable outburst but instead refers to irrational fear or state of emotional shock and anxiety. In most cases child abuse accommodation syndrome is turned down, and the courts discount the reports as the child having hysteria. Hysteria is also used in other lengths with Child Sexual Abuse Accommodation Syndrome as well as Day care sex abuse hysteria which was the panic in the 1980's and 1990's. Hysteria is also seen in other scopes in closeness with Child Sexual Abuse Accommodation Syndrome by the family and friends of the victim. They are in so much shock and disbelief as what has taken place that in some situations, in most cases the female figures often turn hysterical.

Media
Child Sexual abuse continues to be discussed in schools and in communities to make members more aware of the issues associated with child sexual abuse. As this awareness is increasing, child sexual abuse victims are being analyzed and evaluated more for victimization. There are several categories that are assessed such as welfare, criminal, mental health, and medical. Thus several professionals are brought into the case to evaluate the victim. Some concerns are evaluation include confidentiality of information and inexperienced evaluators.

Popular Culture
There are millions of children who are sexual abused throughout the world, and are helpless with no one to tell and it is kept a secret for years. Notable individuals, famous celebrities and even athletes have gotten abused as children and have told no one until there early adult lives. Oprah Winfrey, Tyler Perry, Vanessa L. Williams are just a few notable celebrities that have been abused as children. Not only have individuals gotten abused, but media and television shows also demonstrate child abuse as well. Shows as Law and Order or Criminal Minds help demonstrate the abuse and follow by trying to catch the abuser and help the victim. There are also shows as Dr.Phil which help educate individuals and also help specific individuals with there situations. As society makes people educated by using popular culture as a medium, it will make people aware of not only the victims but also the coping devices and the steps needed as the Child Sexual Abuse Accommodation Syndrome to move on.

School Professionals
In the U.S, school professionals of all states have the same responsibility. The teachers and mental health professionals are required to report and notify an authority if they learn that child abuse is occurring. If the professional fails to report the abuse or does not report purposely then they will be held responsible in terms of a criminal liability.

Reporting and Investigation
Society has always seen the need to protect sexually abused and harassed children. In the 1800s several private agencies began to arise that designed programs to protect and serve abused children. These agencies have since made significant efforts to develop an efficient reporting and investigation method. According to the law, in certain states, a child protection agency is authorized to be involved if the victim has been abused by a family member or a caretaker. However, in certain states these agencies are authorized to intervene despite the nature of the case.

Court Case
The first case of the Child Sexual Abuse Accomodation Syndrome was brought forward in Kentucky in 1983, where a female child had been sexually abused by her uncles. A psychiatrist presented in court to observe the behavior of the child, and it was concluded that the victim was exhibiting signs of Child Sexual Abuse Accomodation Syndrome such as secrecy, helplessness, entrapment and acommodation, delayed, conflicted and unconvincing disclosure, and retraction which are commonly seen in children that have been sexually abused by a relative. However, the psychiatrist was unable to determine whether the behavior exhibited was a direct result of the sexual abuse of that the abuse was at the hands of the accused.

During the trial the defendant had objected to the claim of Child Sexual Abuse Accomodation Syndrome on the grounds that the Child Sexual Abuse Accomodation Syndrome was not medically accepted at that time as little was known about the syndrome. On this basis the court dismissed the case.

Following the dismissal of the case, professionals such as social workers, teachers and police intervened and objected as a videotape of the child’s description of the sexual abuse was available. These professionals analyzed the videotape, that contained the initial statements provided by the victimized child. According to the statements it was clear that the abuse had occured and post abuse the child was displaying symptoms of the Child Sexual Abuse Accomodation Syndrome. These symptoms included: secrecy, helplessness, entrapment and acommodation, delayed, conflicted and unconvincing disclosure, and retraction. At one point in the trial, the child victim had taken back the claim of sexual abuse. Also, the child altered the occurrence of events and it seemed that the child was hesitating to provide any statements. During this point in the trial an expert with a master’s degree in family sociology was brought in by court orders to intervene and analyze the child's behaviour. The professional pointed out that the reason why the child had changed statements was due to family pressure and family honor. This is what is referred to as retraction, the last stage of the syndrome.

Case Studies of Individuals
Many of the following case studies will not reveal any names as the victims who suffered the abuse were under the age of consent.

This was a letter mailed by a women who suffered from child sexual abuse. It perfectly shows how the victims are subjected to secrecy and helplessness even when they grow up. "Last week my 32-year-old sister told me she had been sexually molested by our father from age 6 to 16. I was stunned because for 20 years I had kept the same secret from anyone. I am now 30. We decided to talk to our three other sisters, all in their 20's. It turned out that our father had sexually molested each and every one of us. We all thought we were being singled out for that humiliating, ugly experience, and were too ashamed and frightened to tell anyone, so we all kept our mouths shut. Father is now 53. To look at him, you would think he was the all-American dad. Mom is 51. She would die if she had any idea of what he had been doing to his daughters all these years"

This is the story of two brothers who were sexual abused by the camp counselor.

Two boys aged 9 (A) and 11 (B) became friends with their camp counselor (C) while he was teaching them art and crafts. They remained their friendship after camp, and since the boys adored C so much, their parents allowed C to stay over night with the boys in their house. One day, C wanted to play a new game with A where C was a photographer and A was a model. He fondle with A as well as B until he was 13. C left the country for he got a new job tutoring young boys. B finally had the courage to tell his mother about the abuse who then went to the police. C came back to the country, pleaded guilty and received three years of probation. Once released, C began to stalk A, telling both A and B they'll never grow up normal and they will one day become molesters too. Both boys feared of this outcome. B tried to commit suicide unsuccessfully, but not long after, his dad had taken his own life as he believed he failed to protect his own sons. A painted a painting dedicated to his father before he himself ended his life with his last words being "I hate you C!" Losing both his father and brother, B did his best to fight against his offender, but less than a year later, B's body was found in his car. The cause of his death, suicide like his father and brother.

Witnesses
Children who are witnesses in a court cases can already be scared, frightened and in shock of everything around them. In child sexual abuse cases it is even harder for the child to talk about what he or she saw in front of so many people. It is typical to delay talking about the incident and at times not talking about it at all. Children who have been sexual abused by a trusted family member or close friend are often faced by intimidation and keep the incident a secret. In sexual abuse cases children behaviors may not go along with the courts understanding of how a child should react. This can result in the courts understanding that the story was fabricated because she/he did not report it immediately, or retracted an accusation. The child sexual abuse accommodation syndrome is used in the court system to explain the child's behavior in the court and to establish the child's credibility. There has been many cases where the courts have allowed Child Sexual Abuse Accommodation Syndrome to be used, starting in the mid 1980's.Witnesses have also been asked to play with anatomically correct dolls. This allows not only the courts but also health physicians etc. to see if sexual abuse has in fact taken place. Dolls are also used in situations where children who are unable or unwilling to talk can act out what has happened to them. Expert testimony involving Child Sexual Abuse Accommodation Syndrome in criminal trials is controversial because syndrome evidence has been used as a scientific diagnostic tool or as an credibility bolster. The prosecution should only use expert testimony on the Child Sexual Abuse Accommodation Syndrome to explain seemingly inconsistent behavior or recantation by the child and to rebut the defense contention that the abuse never occurred because of the child's delayed and unconvincing disclosure, recantation, or other inconsistent behaviors. Used in this way, expert testimony explains how recantation or other behaviors can be understood by reasons other than deceit. The prosecution expert can explain the behavioral dynamics resulting from feelings of betrayal caused by the actions of the abuser and the rest of the family who failed to protect her or did not believe her eventual disclosure. Summit notes: The proper foundation for relevance of Child Sexual Abuse Accommodation Syndrome testimony is the inference raised by the defense that an inconsistent pattern of disclosures by the child is indicative of deceit. An abstract presentation of the Child Sexual Abuse Accommodation Syndrome by an expert who has never seen the child and knows virtually nothing about the case provides the jury with a demonstrably objective refection. There is no possibility that such an expert has couched the testimony to buttress the credibility of percipient witnesses. Ideally, the jury will be allowed to understand what is normal and real for child victims as a class, even if courts persist in seeing such conditions as pathological. where courts ruled that no expert gave their own opinions, instead discussed factors staying away from individual assessments. This can help the jury weigh with the victims testimony and was a positive case, because of the correct witness testimony.